Blood Transfusion Reduction in Cardiac Surgery: Multidisciplinary Approach at a Community Hospital

Brevig, James; McDonald, Julie; Zelinka, Edy S.; Gallagher, Trudi; Jin, Ruyun; Grunkemeier, Gary L.

doi:10.1016/j.athoracsur.2008.10.044

Cited by 75 publications

(58 citation statements)

References 16 publications

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“…24 In such cases, efforts directed at implementing a hospital wide quality improvement program improved guideline adherence rates. 25 In our study, a comparable percentage of the variation in MIBB use was attributable to the facility at 28.8%. We identified lower volume facilities and smaller facilities as having lower rates of MIBB use.…”

Section: Discussionsupporting

confidence: 61%

Surgeon and Facility Variation in the Use of Minimally Invasive Breast Biopsy in Texas

et al. 2015

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OBJECTIVE AND SUMMARY BACKGROUND DATA Minimally invasive breast biopsy (MIBB) rates remain well below guideline recommendations of >90% and varies across geographic areas. Our aim was to determine the variation in use attributable to the surgeon and facility and determine the patient, surgeon, and facility characteristics associated with use of MIBB. METHODS We used 100% Texas Medicare claims data (2000–2008) to identify women >66 years with a breast biopsy (open or minimally invasive) and subsequent breast cancer diagnosis/operation within 1 year. The percentage of patients undergoing MIBB as the first diagnostic modality was estimated for each surgeon and facility. Three-level hierarchical generalized linear models (patients clustered within surgeons within facilities) were used to evaluate variation in MIBB use. RESULTS 22,711 patients underwent a breast cancer operation by 1,226 surgeons at 525 facilities. MIBB was the initial diagnostic modality in 62.4% of cases. Only 7.0% of facilities and 12.9% of surgeons used MIBB in >90% of patients. In 3-level models adjusted for patient characteristics, the percentage of patients who received MIBB ranged from 7.5%–96.0% across facilities (mean 50.1%, median 49.2%) and from 8.0% to 87.0% across surgeons (mean 50.3%, median 50.9%). 28.8% of the variance in MIBB was attributable to the facility and 15.4% to the surgeon. Lower surgeon and facility volume, longer surgeon years in practice and smaller facility bed size were associated with lower rates of MIBB use. CONCLUSION Identification of surgeon and facility characteristics associated with low use of MIBB provides potential targets for interventions to improve MIBB rates and decrease variation in use.

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Section: Discussionsupporting

confidence: 61%

Surgeon and Facility Variation in the Use of Minimally Invasive Breast Biopsy in Texas

et al. 2015

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“…Although not currently commercially available in the United States and many other counties due to safety concerns, the 2011 guidelines suggest a possible use for aprotinin, which may be released on a case-by-case or compassionate-use basis, in instances where there is a high risk of bleeding or where transfusion is not an option (eg, Jehovah's Witnesses) [5]. In 2009, Brevig et al [66] reported on their experience with a multidisciplinary, multimodality blood conservation strategy in more than 2500 patients undergoing cardiac surgery in a community hospital setting. Over several years, the investigators have used a variety of preoperative, intraoperative, and postoperative interventions, in an effort to decrease in the rate of PRBC transfusion in patients undergoing cardiac surgery.…”

Section: Alternatives To Prbc Transfusionmentioning

confidence: 98%

Risks of packed red blood cell transfusion in patients undergoing cardiac surgery

Gerber

2012

Journal of Critical Care

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“…As stated by B. D. Spiess, MD, FAHA, BIt can only be concluded from all the papers together that the usage of transfusion and the usage of aprotinin are closely intertwined, meaning that the ability to separate them as true cause and effect by retrospective analysis is at best a statistical three-ringed circus^ [16]. Brevig et al [17], after adopting a multidisciplinary approach to blood conservation from 2003 to 2007, reported a drastic reduction in PRBC transfusion from 43 to 18 %. In 2012, Xydas et al [18] also reported similar results after implementation of a blood conservation program.…”

Section: Discussionmentioning

confidence: 98%

Adult cardiac surgery blood/blood product utilization in the post aprotinin era: an 855 patient, community hospital, retrospective experience

Sharma

Al-Achi

Behrend

et al. 2016

Indian J Thorac Cardiovasc Surg

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Background and objectives Prior to 2008, when it was withdrawn, aprotinin use in cardiac surgery patients was associated with reduced bleeding and blood utilization, but studies linked its administration to increased patient mortality. We investigated (a) blood/blood product utilization between 2008 and 2013 at our community hospital heart center according to the type of surgery performed following the withdrawal of aprotinin and (b) clinical variables associated with increased patient blood utilization. Materials and methods Seven hundred nine patients were retrospectively investigated for blood/blood product utilization. Variables examined were patient age, body surface area (BSA), gender, preoperative creatinine level, hematocrit level, total cell saved blood (CSB) administered, cardiopulmonary bypass (CPB) time, type of surgical procedure performed, and preoperative clopidogrel usage. Variables (categorical and continuous) were placed into a forward stepwise regression model for the continuous outcome, packed red blood cell (PRBC) utilization. The stepwise function utilized a P value threshold of 0.25 for entering the model and 0.1 for leaving the model. Results For coronary artery bypass graft (CABG) surgery, use of PRBC was 29.26 % (0.75/1.44), of platelets was 14.18 % (0.24/0.72), of fresh frozen plasma (FFP) was 7.34 % (0.19/ 0.78), and of cryoprecipitate was 10.63 % (0.23/0.97) among our patient sample. [Data expressed as percent patient utilization, mean/S.D. in units transfused]. Increased age, smaller BSA, higher preoperative creatinine level, lower preoperative hematocrit level, longer CPB time, and increased CSB administration was associated with increased PRBC administration (P < 0.0001). Conclusion At our community heart surgery center, with a multidisciplinary blood conservation program in place, expected increase in blood/blood product utilization following aprotinin withdrawal was not experienced.

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Blood Transfusion Reduction in Cardiac Surgery: Multidisciplinary Approach at a Community Hospital

Cited by 75 publications

References 16 publications

Surgeon and Facility Variation in the Use of Minimally Invasive Breast Biopsy in Texas

Surgeon and Facility Variation in the Use of Minimally Invasive Breast Biopsy in Texas

Risks of packed red blood cell transfusion in patients undergoing cardiac surgery

Adult cardiac surgery blood/blood product utilization in the post aprotinin era: an 855 patient, community hospital, retrospective experience

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